Browsing by Author "Gunday, Murat"

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Can Preoperative Erythrocyte Sedimentation Rate Serve as an Indicator for Midterm Adverse Events after Coronary Bypass Grafting?
(2015) Togan, Turhan; Gunday, Murat; Ciftci, Ozgur; Bingol, Hakan; 0000-0002-6463-6070; 25924030; A-7318-2017
Objective: Erythrocyte sedimentation rate (ESR) may serve as a reasonably-good indicator for coronary heart disease as usually ESR is elevated in these patients. The measurement of ESR is a very simple and cheap laboratory test that can he performed in routine blood examinations. In this study, we investigated the association between preoperative erythrocyte sedimentation rate and postoperative midterm adverse events after coronary artery bypass grafting (CABG). Methods: In the study, only male patients were included. The patients were divided into two groups: group 1 (preoperative sedimentation rate [<20 mm/h] normal [n = 232, 63.9%]) and group 2 (preoperative sedimentation rate [>20 mm/h] above normal [n = 131, 36.1%]). The hemogram and biochemistry panel values were measured one day before operation, on the postoperative first day, on the postoperative seventh day, and on the postoperative third month. Results: Among the laboratory values, there was a statistically significant difference between the two groups with respect to postoperative first-day ESR and postoperative third-month high-sensitivity C-reactive protein (P < .05). In terms of postoperative morbidity, there was also a statistically significant difference (P < .05) between the two groups with regard to pleural effusion, infection of the soft tissue over the sternum, pulmonary infection, return to the intensive care unit, rehospitalization, and mortality. Conclusion: Elevated preoperative sedimentation rate is associated with postoperative adverse events in patients who undergo CABG. For this purpose, we suggest that patients with higher sedimentation rates undergo detailed examination to prevent mortality and morbidity.
Comparison of Platelet Mass Index in On-Pump and Off-Pump Coronary Artery Bypass Surgery
(2020) Gunday, Murat; Ciftci, Ozgur; 32364905
Introduction: Platelet mass index (PMI) is calculated by multiplying platelet count and mean platelet volume (MPV). It demonstrates platelet activation and is thought to be associated with inflammation. Its importance for cardiac surgery has not yet fully been clarified. This study investigates whether there is a difference between PMI levels after on-pump and off-pump coronary artery bypass surgery and the relationship between early postoperative complications and PMI. Method: In our hospital, 138 patients were included in the study retrospectively. The patients were divided into 2 groups: Group 1 (on-pump) with 80 patients (22 females, 58 males, mean age 61.54 +/- 8.68) and Group 2 (off-pump) with 58 patients (15 females, 43 males, mean age 61.34 +/- 10.04). In biochemical analysis, hemoglobin, platelet, white blood cell, and MPV values of the patients were evaluated in the biochemistry laboratory of our hospital with the blood taken preoperatively from the forearm veins and postoperatively on the first, third, and seventh days and, on average, after the first month. Results: There was a statistically significant difference between postoperative first day thrombocyte (K/mu L) (P = .005), postoperative first day PMI (P = .014), postoperative first day leukocyte (K/mu L) (P = .001), postoperative first day Hb (g/dL) (P = .001), postoperative third day thrombocyte (K/mu L) (P = .003), postoperative third day PMI (P = .031), postoperative third day leukocyte (K/mu L) (P = .004), and postoperative seventh day leukocyte (K/mu L) (P = .002). There was no meaningful relationship between PMI and early postoperative complications. Conclusion: We think PMI is a more valuable indicator than MPV as an inflammation marker in cardiac surgery. In our opinion, PMI is a cheap and valuable inflammation marker that can be used in coronary surgery that can be obtained from routine hemogram test and can easily be evaluated.
Does Brucellosis Cause Arterial Stiffness and Ventricular Remodelling Through Inflammation?
(2015) Togan, Turhan; Ciftci, Ozgur; Gunday, Murat; Narci, Huseyin; Arslan, Hande; 0000-0002-6636-9391; 0000-0002-5708-7915; 0000-0002-6463-6070; 26148379; L-7182-2015; ABG-7034-2021; A-7318-2017
Background Like other acute and chronic infections, Brucella infection leads to endothelial dysfunction. Furthermore, it has been suggested that the chronic inflammatory state present in chronic infectious diseases leads to an acceleration in atherosclerosis. For the prediction of CAD, it is possible to use epicardial fat thickness (EFT) as an adjunctive marker beside the classical risk factors, as it is easily and non-invasively evaluated by transthoracic echocardiography. The purpose of this study was to investigate the presence of impaired myocardial performance as well as of increased arterial stiffness and EFT in patients who had been infected with brucellosis in the past. Methods Included in the study were twenty-seven brucellosis patients and twenty-six healthy volunteers. Using EFT and transthoracic echocardiography, which included Doppler echocardiography in combination with tissue Doppler imaging (TDI), all the patients were examined to measure their aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM) values. Results A statistically significant increase was observed in hs-CRP, aortic stiffness index, aortic elastic modulus and EFT in brucellosis patients when compared with the controls (2.46 +/- 1.40 vs 1.71 +/- 0.61, P=0.016; 9.69 +/- 6.99 vs 2.14 +/- 0.72, P < 0.001; 11.17 +/- 8.60 vs 2.18 +/- 0.90, P < 0.001; 0.76 +/- 0.08 vs 0.63 +/- 0.10, P < 0.001). On the other hand, there was a significant decrease in aortic strain and aortic distensibility (7.41 +/- 6.82 vs 18.26 +/- 5.83, P < 0.001; 1.83 +/- 1.71 vs 5.22 +/- 1.72, P < 0.001, respectively). No difference was observed between the two groups with respect to the left ventricular myocardial performance index (MPI) (0.62 +/- 0.15 vs 0.61 +/- 0.13, P=0.859). Conclusions In this study, we demonstrated for the first time in the literature that there was impaired aortic elasticity and increased EFT in patients with brucellosis, while the myocardial performance index remained unaffected. We also determined that these effects had a significant correlation with inflammation.
Effects of Cardiopulmonary Bypass on Mediastinal Drainage and the Use of Blood Products in the Intensive Care Unit in 60-to 80-Year-Old Patients Who Have Undergone Coronary Artery Bypass Grafting
(2015) Aygun, Fatih; Ozuklu, Mehmet; Gunday, Murat; 26934397
Objective: The present study consisted of patients who underwent on-pump coronary artery bypass grafting (CABG) and off-pump CABG and investigated effect of using cardiopulmonary bypass (CPB) on the amount of postoperative drainage and blood products, red blood cell (RBC), free frozen plasma (FFP) given in the intensive care unit in 60-80-year-old patients who underwent CABG. Methods: The present study comprises a total of 174 patients who have undergone coronary artery bypass graft (off-pump or on-pump CABG) surgery in our clinic in between 2012-2015 year. Results: It was observed that the amount of drainage in the first 24 postoperative hours was lower in the on-pump CABG group (Group 1) when compared to off-pump group (Group 2) (Group 1 vs. Group 2; 703.5 +/- 253.8 ml vs. 719.6 +/- 209.4 ml; P=0.716). However, the amount of drainage in the second 24 hours was statistically significantly lower in the off-pump CABG group (Group 1 vs. Group 2; 259.8 +/- 170.6 ml vs. 190.1 +/- 129.1 ml; P=0.016). With regard to the amount of overall drainage, no statistically significant difference was observed between the two groups. Group 1 needed RBC transfusion higher than Group 2 (Group 1 vs. Group 2; 2.2 +/- 1.3 bag vs. 1.2 +/- 0.9 bag; P<0.001). Conclusion: We can say that CPB influences the amount of second 24-hour drainage which indexed body surface area. In addition, CPB decreases hct, hb, thrombocyte count in ICU arrived, after 24 hours in postoperative period. Reduced thrombocyte counting effect can be appeared after 48 hours in the postoperative period of CPB.
Is crystalloid cardioplegia a strong predictor of intra-operative hemodilution?
(2014) Gunday, Murat; Bingol, Hakan
Introduction: Complications due to hemodilution (hematocrit value less than 22%) after cardiopulmonary bypass inevitably resulted with significantly greater intensive care requirements, long hospital stays, more operative costs, and increased mortality rates. We tried to identify whether crystalloid cardioplegia is the strongest predictor of intraoperative hemodilution or not. Materials and methods: One hundred patients were included into this randomized prospective study. Patients were divided into the two groups. Crystalloid cardioplegia were given to the odd-numbered patients (Group 1, n = 50 patients) and blood cardioplegia were given to the even-numbered patients (Group 2, n = 50 patients). St. Thomas-II solution was used in Group-1 and Calafiore cold blood cardioplegia was in Group-2. Results: Average intraoperative hematocrit value was 18.4% +/- 2.3 in crystalloid group 24.2% +/- 3.4 in blood cardioplegia group (p < 0.001). The lowest hematocrit value was 15% and 20% in two groups respectively (p < 0.001). In crystalloid group average intraoperative packed red blood cell (RBC) transfusion was 2.3 +/- 0.41 units, 0.7 +/- 0.6 units blood cardioplegia group (p = 0.001). Average transfused RBC was 2.7 +/- 0.8 units in crystalloid group, 0.9 +/- 0.4 units blood cardioplegia group (p < 0.001). Multivariate analyses confirmed age (p = 0.005, OR = 3.78), female gender (p = 0.003, OR = 2.91), longer cross-clamp time (>60 minutes) (p = 0.001, OD = 0.97), body surface area <1.6 m(2) (p = 0.001, OR = 6.01) and crystalloid cardioplegia (p < 0.001, OR = 0.19) as predictor of intraoperative hemodilution. Conclusion: Crystalloid cardioplegia, compared to blood cardioplegia not only causes much more intra-operative hemodilution but also increases the blood transfusion requirement. Hemodilution and increased transfusion increases the intensive care unit and hospital stay, in the early postoperative period.
Is Off-Pump Coronary Artery Bypass Surgery Superior to On-Pump Coronary Artery Bypass Surgery on Postoperative Paradoxical Ventricular Septal Motion?
(2014) Gunday, Murat; Alpaslan, Mete; Ciftci, Ozgur; Ozulku, Mehmet; Copur, Gulay; Aslamaci, Sait; https://orcid.org/0000-0003-1481-8228; https://orcid.org/0000-0002-6463-6070; 25179970; A-7318-2017
Background: The aims of this study were to investigate the appearance of paradoxical ventricular septal motion (PSM) after coronary artery bypass graft (CABG) surgery and to identify factors that might be related to this abnormality. Methods: This prospective study included 119 consecutive patients (38 women, 81 men) who underwent CABG. Patients who underwent on-pump surgery (22 women, 45 men) and patients who underwent off-pump surgery (16 women, 36 men) were studied separately. All subjects underwent preoperative angiographic septal perfusion evaluation, pre- and postoperative echocardiography, and standard electrocardiographic and laboratory investigations, including troponin I and CK-MB levels. Multivariate logistic regression analysis was also performed for a variety of related parameters. Results: Significant differences in EuroSCORE, length of intensive care unit stay, length of hospital stay, PSM (assessed using echocardiography), septal perfusion (observed using preoperative angiography), postoperative pleural effusion, and intensive care unit recidivism were observed between the two groups (P < .05). Moreover, postoperative PSM was correlated with septal perfusion (r = -0.687**, P < .001), type of operation (r = -0.194*, P = .035), diabetes mellitus (r = 0.273**, P = .003), carotid stenosis (r = 0.235*, P = .011), the number of distal anastomoses (r = 0.245**, P = .008), pleural effusion (r = 0.193*, P = .037), and intensive care unit recidivism (r = 0.249**, P = .007). However, multivariate analysis demonstrated that only preoperative septal perfusion (odds ratio: 0.037; 95% confidence interval: 0.011-0.128; P < .05) constitutes an independent risk factor for PSM (P < .05). Conclusions: This study demonstrated that preoperative septal perfusion deficiency represents an independent risk factor for postoperative PSM in patients undergoing CABG. Further investigations addressing the timing of the appearance of PSM and the correlation of this finding with perfusion imaging studies may provide new details concerning the mechanisms that underlie this abnormality.
Is there a difference between two different skin disinfection methods in cardiac surgery in terms of isolated pathogens?
(2020) Gunday, Murat; Orhan, Atilla; Turan, Hale; Korez, Muslu Kazim; 32683356
Introduction: In this study, our aim was to prospectively compare the different methods of patient disinfections with scrubbing + iodine + alcohol, and the povidone iodine disinfection method, which can be described as classical, in terms of the pathogens isolated on skin and during early postoperative complications. Methodology: Eighty patients undergoing a coronary artery bypass operation were included in the study. The patients were divided into two groups: group 1 (n = 48) patients who underwent scrub, iodine, followed by skin disinfection with alcohol, and group 2 (n = 32) who were treated with povidone iodine three times. The samples were immediately sent to the microbiology laboratory. Specimens from the wounds were incubated under aerobic and anaerobic conditions, and isolates were identified using standard microbiological techniques. Results: In samples taken after disinfection in group 1, significantly less reproduction was observed compared to group 2 (p = 0.001). There was no difference in postoperative complications between the two groups except for pleural effusion (p = 0.040). S. epidermidis was the most frequently isolated pathogen in both groups. Conclusion: We did not find a study which compares scrub + alcohol + iodine and povidone iodine in our literature review. We think that our study is original in this respect. We can conclude that skin disinfection with scrub + alcohol + iodine was superior to using only povidone iodine in terms of the pathogens isolated afterwards from the wound.
Is There an Effect of Preoperative Vitamin D in a New Beginning Atrial Fibrilation Development After Isolated Off-Pump Coronary Artery Bypass?
(2020) Gunday, Murat; Korez, Kazim
Introduction: The aim of our study is to determine whether there is a relationship between preoperatively measured vitamin D, postoperative development of AF and early adverse events and vitamin D in patients with isolated off-pump coronary artery bypass. Method: Fifty five consecutive patients who underwent off-pump coronary bypass in our hospital were included. Patients were divided into two groups group 1 (n = 44) as patients who developed AF at any time within the first five days after the operation.and group 2 non-AF (n = 11). Two groups were examined in terms of preoperative blood vitamin D levels, postoperative AF and postoperative complications. Results: There was no significant difference between the two groups in terms of preoperative vitamin D values (P = 0.850). In terms of postoperative complications, there was no difference between respiratory problem, pleural effusion, wound infection, stroke, dialysis due to kidney failure and mortality (p>0.05). In addition, no difference was found between vitamin D and postoperative complications. Conclusion: In our study for the first time in the literature, it was examined whether there was a relationship between preoperative vitamin D levels and AF development after off-pump coronary bypass. In our study, which was about 1 year and involving all seasons, there was no significant relationship between vitamin D and postoperative AF.
Radial Artery, Saphenous Vein versus Left Internal Thoracic Artery in Recurrent Ischemic Symptoms after Coronary Artery Bypass Graft Surgery
(2014) Gunday, Murat; Coskun, Isa; Ciftci, Ozgur; Ozulku, Mehmet; Tekindal, Mustafa Agah; Guven, Aytekin; Aslamaci, Sait; https://orcid.org/0000-0002-6463-6070; https://orcid.org/0000-0002-4060-7048; 25065278; A-7318-2017; U-9270-2018; AAJ-8546-2021
Background: The long-term results of coronary artery bypass surgery depend mostly on the type of the grafts. For a long time, it has been accepted that arterial grafts are superior to venous grafts. In this study, we evaluated the angiographic patency rates of arterial and venous grafts. Methods: The study took place between 2003 and 2013 in the Departments of Cardiovascular Surgery in Baskent University. The study included 52 patients with recurrent ischemic symptoms (of total 2183 coronary artery bypass surgery patients) following coronary artery bypass surgery. The patients were evaluated by control angiography during over mid- and long-term postoperative period (mean, 75.25 +/- 35.15 months). Based on the angiographic findings, the grafts were divided into 3 groups: severe stenosis, moderate stenosis, and patent. Results: The preoperative demographics (age, gender, hypertension or diabetes mellitus) were similar in the three groups. The mean numbers of distal anastomoses were 3.27 +/- 0.89 (range 2-5), the degree of native coronary artery stenosis for radial artery anastomosis was 79.65 +/- 17.72, and the mean numbers of radial artery and saphenous vein grafts were 1.19 +/- 0.44 and 1.10 +/- 0.89, respectively. The patency rate was 80.77%for radial arteries, 63.2% for saphenous veins, and 82.4% for left internal thoracic arteries in the three groups. Conclusion: The internal thoracic artery graft was confirmed to be the best option for aorta-coronary bypass surgery, as it has the highest patency rate compared to the other grafts. Radial artery and saphenous vein patency rate were also seen to be similar in the long-term.
Serum Uric Acid and Carotid Artery Intima Media Thickness in Patients with Masked Hypertension
(2014) Caliskan, Mustafa; Guven, Aytekin; Ciftcl, Ozgur; Ozulku, Mehmet; Gunday, Murat; Barutcu, Irfan; https://orcid.org/0000-0002-6463-6070; 25181917; AAJ-8546-2021; A-7318-2017
Background Serum uric acid is related to hypertension and cardiovascular diseases. Masked hypertension is associated with an increase in cardiovascular risk. The aim of our study was to evaluate the serum uric acid level and its relationship with carotid intima-media thickness (IMT) in patients with masked hypertension. Subjects and methods A total of 114 untreated masked hypertension patients (62 men, 52 women; mean age 44.6 +/- 7.9 years) and 38 controls (20 men, 18 women; mean age 44.8 +/- 7 years) were included in the study. All patients underwent 24-hour ambulatory blood pressure. Serum uric acid and carotid IMT were measured. Results Serum uric acid was significantly higher in masked hypertension patients when compared to the control group (5.14 +/- 1.42 mg/dl, 4.84 +/- 1.45 mg/ dl, P=0.01). Masked hypertension patients had significantly higher carotid IMT than control subjects (0.58 +/- 0.09, 0.52 +/- 0.09, P < 0.001). The masked hypertension group was also divided into two groups according to the median value of the serum uric acid levels (median value: 5 mg/dl). Carotid IMT was significantly higher in patients with a higher uric acid when compared to those with a lower uric acid (P < 0.001). We also found that the serum uric acid level was a good predictor of increased carotid IMT at the receiver-operating characteristic curve. The area under the curve was 66% (95% confidence interval, 0.56-0.77), and the serum uric acid level was significantly predictive of a high carotid IMT (P=0.001). Conclusions Our data suggest that the uric acid levels were significantly higher in the masked hypertension group and elevated uric acid levels were associated with increased carotid IMT, indicating that elevated serum uric acid levels might contribute to the increase in cardiovascular risk in masked hypertension.